1. Transfusion Therapy Jolene Bethune, RN, MSN

2. Objectives

3. Provide overview of transfusion therapy. Describe pre-transfusion responsibilities. Describe transfusion responsibilities.

4. Describe post-transfusion responsibilities. Describe types of transfusions. Describe transfusion reactions. Describe autologous transfusions.

5. Overview

6. Any blood component may be removed from a donor and transfused into a recipient.

7. Most of the blood supply in the US is donated by provided by volunteers, donated at a site that is convenient to their work or home.

8. Blood components may be transfused individually or collectively depending, with varying degrees of benefit to the recipient.

9. Pre-transfusion Responsibilities

10. Pre-transfusion Responsibilities Assess laboratory values.

11. Verify the medical prescription.

12. Assess the client’s vital signs, urine output, skin color and history of transfusion reactions.

13. Obtain venous access. Use a central catheter or at least a 20-gauge needle, if possible.

14. Obtain blood products from a blood bank; transfuse immediately.

15. With another registered nurse, verify the patient by name and number, check blood compatibility and note expiration time.

16. Administer the blood product using the appropriate filtered tubing.

17. If the blood product needs to be diluted, use only normal saline solution

18. Remain with the patient during the first 15-30 minutes of the infusion.

19. Infuse the blood product at the prescribed rate.

20. Monitor vital signs.

21. Types of Transfusions

22. Packed Red Blood Cells Given to replace cells lost due to trauma, surgery or conditions that destroy RBCs or impair RBC maturation. Supplied in 250ml bags. Most common blood component given.

23. Packed Red Blood Cells Given to patients who with HGB < 8g/dL or who are hypoxemic. Actually a transplant of tissue. Infuse with special tubing. Requires ABO compatibility.

24. Platelets Given to patients with PLT counts < 10,000mm3 or who have thrombocytopenia and have active bleeding or are scheduled for an invasive procedure. Packed in bags of 300ml from pooled donors or 200ml from a single donor. Infused over 15-30-minute period. Infuse with special tubing.

25. Fresh Frozen Plasma Contains clotting factors and can be used for patients with clotting disorders. Used for patients who are actively bleeding with a PT/PTT greater than 1.5 times normal rate. Requires ABO compatibility. Comes in 200ml bags. Infuse over 30-60 minutes. Use regular Y set or filtered tubing.

26. Cryoprecipitate Derived from plasma. For clients with clotting factor disorders. Contains clotting factors VIII and XIII, von Willebrand’s factor and fibrinogen. For clients with fibrinogen level <100mg/dL. Infuse @ 10-15mL/unit; usually given by IV push within 3 minutes. Should be ABO compatible.

27. Granulocytes (WBC) For clients with infections. Suspended in 400ml plasma. Infuse in 45-60 minutes. Take VS q15min throughout the transfusion.

28. Transfusion Reactions

29. Febrile – caused by anti-WBC antibodies Chills Tachycardia Fever

30. Hypotension Tachypnea WBC filters used to trap WBCs ad prevent their infusion

31. Hemolytic Caused by RH incompatibility Reaction may be mild, with fever/chills or life-threatening, with DIC

32. Symptoms include: Apprehension Headache Chest pain

33. Low back pain Tachycardia Tachypnea Hypotension Hemoglobinuria A sense of impending doom

34. Allergic Urticaria Itching Bronchospasm

35. Anaphylaxis Prevented by giving leukocyte-reduced or washed RBCs in which the WBCs and plasma have been removed.

36. Bacterial Results from contaminated blood products. Tachycardia Hypotension

37. Fever Chills Shock

38. Circulatory Overload Occurs when blood is given too quickly Dyspnea Restlessness Confusion

39. Hypertension Bounding pulse Distended jugular veins Monitor I/O, infuse blood products slowly and giving diuretics

40. Transfusion-associated graft-versus-host disease (TA-GVHD). Donor T-cells attack host tissues. Symptoms occur within 1-2 weeks Thrombocytopenia

41. Anorexia Nausea Vomiting

42. Chronic hepatitis Weight loss Recurrent infection

43. Autologous Blood Transfusions Collection/infusion of client’s own blood

44. Four types: Preoperative autologous blood donation Acute normovolemic hemodilution Intra-operative autologous transfusion Postoperative blood salvage

45. Preoperative autologous blood donation Collecting whole blood from the client, dividing it into components and storing it for later use Can be collected weekly as long as client’s H&H are within safe range Can be stored up to 40 days; up to 10 years for rare blood types.

46. Acute normovolemic hemodilution Withdrawal of client’s RBCs and volume replacement just before a procedure Goal is to decrease RBC loss during surgery Blood is stored at room temperature for up to 6hrs and reinfused after surgery. Not for anemic clients or those with poor kidney function.

47. Intra-operative autologous transfusion & Post operative blood salvage Recovery/reinfusion of client’s own blood from operative field or bleeding wound. Special devices collect, filter, drain blood into transfusion bag Used for trauma or surgical patients with severe blood loss Blood must be reinfused within 6 hours.

48. Reference Ignatavicius, D. D., & Workman, M. L. (2010). Medical-surgical nursing: patient-centered collaborative care(6 ed.). Philadelphia, PA: W. B. Saunders Company.